MEDICARE: KIDS DENTISTREE OF KY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry

General Provider Information

NPI Number	:	1588204655
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIDS DENTISTREE OF KY LLC

Provider Business Mailing Address
First Line	:	PO BOX 437169
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40253-7169
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8727 OLD BARDSTOWN RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40291-4490
Country	:	US
Telephone Number	:	502-254-8500
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	JEFF REIBEL
Credential	:
Telephone Number	:	502-254-8500

Provider Enumeration Date	:	01/07/2020
Last Update Date	:	09/06/2023

Similar Medicare Providers

1063097467 — BENJAMIN SPEELMAN BCBA
Practice Location Address:

8735 OLD BARDSTOWN RD
LOUISVILLE, KY
40291-4490

Practice Phone: 502-427-6040
Practice Fax:

1841753878 — NADYA MARINA GADBERRY BCBA
Practice Location Address:

8739 OLD BARDSTOWN RD
LOUISVILLE, KY
40291-4490

Practice Phone: 502-208-6650
Practice Fax:

1811538499 — CAMILLE SVENDSEN BCBA
Practice Location Address:

8735 OLD BARDSTOWN RD
LOUISVILLE, KY
40291-4490

Practice Phone: 502-208-6650
Practice Fax:

1164114047 — DR. GILLIAN ELISE CASEY DMD, MSD
Practice Location Address:

8727 OLD BARDSTOWN RD
LOUISVILLE, KY
40291-4490

Practice Phone: 502-200-1173
Practice Fax:

1306631619 — MIRANDA TAYLOR GIBBS BCBA
Practice Location Address:

8735 OLD BARDSTOWN RD
LOUISVILLE, KY
40291-4490

Practice Phone: 502-208-6650
Practice Fax:

1306879408 — LISA BAKER SCHOEN MD
Practice Location Address:

4710 CHAMPIONS TRACE LN STE 107
LOUISVILLE, KY
40218-4490

Practice Phone: 24-546-3435
Practice Fax: 502-459-9209

Directions to “KIDS DENTISTREE OF KY LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.